Transcription
37990Federal Register / Vol. 82, No. 155 / Monday, August 14, 2017 / Rules and RegulationsDEPARTMENT OF HEALTH ANDHUMAN SERVICESCenters for Medicare & MedicaidServices42 CFR Parts 405, 412, 413, 414, 416,486, 488, 489, and 495[CMS–1677–F]RIN 0938–AS98Medicare Program; Hospital InpatientProspective Payment Systems forAcute Care Hospitals and the LongTerm Care Hospital ProspectivePayment System and Policy Changesand Fiscal Year 2018 Rates; QualityReporting Requirements for SpecificProviders; Medicare and MedicaidElectronic Health Record (EHR)Incentive Program Requirements forEligible Hospitals, Critical AccessHospitals, and Eligible Professionals;Provider-Based Status of Indian HealthService and Tribal Facilities andOrganizations; Costs Reporting andProvider Requirements; AgreementTermination NoticesCenters for Medicare andMedicaid Services (CMS), HHS.ACTION: Final rule.AGENCY:We are revising the Medicarehospital inpatient prospective paymentsystems (IPPS) for operating and capitalrelated costs of acute care hospitals toimplement changes arising from ourcontinuing experience with thesesystems for FY 2018. Some of thesechanges implement certain statutoryprovisions contained in the Pathway forSustainable Growth Rate (SGR) ReformAct of 2013, the Improving MedicarePost-Acute Care Transformation Act of2014, the Medicare Access and CHIPReauthorization Act of 2015, the 21stCentury Cures Act, and otherlegislation. We also are making changesrelating to the provider-based status ofIndian Health Service (IHS) and Tribalfacilities and organizations and to thelow-volume hospital paymentadjustment for hospitals operated by theIHS or a Tribe. In addition, we areproviding the market basket update thatwill apply to the rate-of-increase limitsfor certain hospitals excluded from theIPPS that are paid on a reasonable costbasis subject to these limits for FY 2018.We are updating the payment policiesand the annual payment rates for theMedicare prospective payment system(PPS) for inpatient hospital servicesprovided by long-term care hospitals(LTCHs) for FY 2018.In addition, we are establishing newrequirements or revising existingsradovich on DSK3GMQ082PROD with RULES2SUMMARY:VerDate Sep 11 201423:27 Aug 11, 2017Jkt 241001requirements for quality reporting byspecific Medicare providers (acute carehospitals, PPS-exempt cancer hospitals,LTCHs, and inpatient psychiatricfacilities). We also are establishing newrequirements or revising existingrequirements for eligible professionals(EPs), eligible hospitals, and criticalaccess hospitals (CAHs) participating inthe Medicare and Medicaid ElectronicHealth Record (EHR) IncentivePrograms. We are updating policiesrelating to the Hospital Value-BasedPurchasing (VBP) Program, the HospitalReadmissions Reduction Program, andthe Hospital-Acquired Condition (HAC)Reduction Program.We also are making changes relatingto transparency of accreditingorganization survey reports and plans ofcorrection of providers and suppliers;electronic signature and electronicsubmission of the Certification andSettlement Summary page of theMedicare cost reports; and clarificationof provider disposal of assets.DATES: This final rule is effective onOctober 1, 2017.FOR FURTHER INFORMATION CONTACT:Donald Thompson, (410) 786–4487,and Michele Hudson, (410) 786–4487,Operating Prospective Payment, MS–DRGs, Wage Index, New MedicalService and Technology Add-OnPayments, Hospital GeographicReclassifications, Graduate MedicalEducation, Capital Prospective Payment,Excluded Hospitals, Sole CommunityHospitals, Medicare DisproportionateShare Hospital (DSH) PaymentAdjustment, Medicare-Dependent SmallRural Hospital (MDH) Program, andLow-Volume Hospital PaymentAdjustment Issues.Michele Hudson, (410) 786–4487,Mark Luxton, (410) 786–4530, andEmily Lipkin, (410) 786–3633, LongTerm Care Hospital ProspectivePayment System and MS–LTC–DRGRelative Weights Issues.Mollie Knight, (410) 786–7948, andBridget Dickensheets, (410) 786–8670,Rebasing and Revising the HospitalMarket Basket Issues.Siddhartha Mazumdar, (410) 786–6673, Rural Community HospitalDemonstration Program Issues.Jeris Smith, (410) 786–0110, FrontierCommunity Health Integration ProjectDemonstration Issues.Lein Han, (617) 879–0129, HospitalReadmissions Reduction Program—Readmission Measures for HospitalsIssues.James Poyer, (410) 786–2261, HospitalReadmissions Reduction Program—Administration Issues.PO 00000Frm 00002Fmt 4701Sfmt 4700Elizabeth Bainger, (410) 786–0529,Hospital-Acquired Condition ReductionProgram Issues.Joseph Clift, (410) 786–4165,Hospital-Acquired Condition ReductionProgram—Measures Issues.Grace Im, (410) 786–0700, and JamesPoyer, (410) 786–2261, HospitalInpatient Quality Reporting andHospital Value-Based Purchasing—Program Administration, Validation,and Reconsideration Issues.Reena Duseja, (410) 786–1999, andCindy Tourison, (410) 786–1093,Hospital Inpatient Quality Reporting—Measures Issues Except HospitalConsumer Assessment of HealthcareProviders and Systems Issues; andReadmission Measures for HospitalsIssues.Kim Spaulding Bush, (410) 786–3232,Hospital Value-Based PurchasingEfficiency Measures Issues.Elizabeth Goldstein, (410) 786–6665,Hospital Inpatient Quality Reporting—Hospital Consumer Assessment ofHealthcare Providers and SystemsMeasures Issues.James Poyer, (410) 786–2261, PPSExempt Cancer Hospital QualityReporting Issues.Mary Pratt, (410) 786–6867, LongTerm Care Hospital Quality DataReporting Issues.Jeffrey Buck, (410) 786–0407, andCindy, Tourison (410) 786–1093,Inpatient Psychiatric Facilities QualityData Reporting Issues.Lisa Marie Gomez, (410) 786–1175,EHR Incentive Program Clinical QualityMeasure Related Issues.Kathleen Johnson, (410) 786–3295,and Steven Johnson (410) 786–3332,EHR Incentive Program NonclinicalQuality Measure Related Issues.Caecilia Blondiaux, (410), 786–2190,and Ariadne Saklas, (410) 786–3322,Changes in Notice of Termination ofMedicare Providers and SuppliersIssues.Monda Shaver, (410) 786–3410, andPatricia Chmielewski, (410) 786–6899,Accrediting Organizations SurveyReporting Transparency Issues.Kellie Shannon, (410) 786–0416,Medicare Cost Reporting and Valuationof Assets Issues.SUPPLEMENTARY INFORMATION:Electronic AccessThis Federal Register document isavailable from the Federal Registeronline database through Federal DigitalSystem (FDsys), a service of the U.S.Government Printing Office. Thisdatabase can be accessed via theInternet at: http://www.gpo.gov/fdsys.E:\FR\FM\14AUR2.SGM14AUR2
Federal Register / Vol. 82, No. 155 / Monday, August 14, 2017 / Rules and RegulationsTables Available Only Through theInternet on the CMS Web SiteIn the past, a majority of the tablesreferred to throughout this preambleand in the Addendum to the proposedrule and the final rule were publishedin the Federal Register as part of theannual proposed and final rules.However, beginning in FY 2012, some ofthe IPPS tables and LTCH PPS tables areno longer published in the FederalRegister. Instead, these tables generallywill be available only through theInternet. The IPPS tables for this finalrule are available through the Interneton the CMS Web site at: rvice-Payment/AcuteInpatientPPS/index.html. Click on the link on theleft side of the screen titled, ‘‘FY 2018IPPS Final Rule Home Page’’ or ‘‘AcuteInpatient—Files for Download’’. TheLTCH PPS tables for this FY 2018 finalrule are available through the Interneton the CMS Web site at: e-Payment/LongTermCareHospitalPPS/index.html under thelist item for Regulation Number CMS–1677–F. For further details on thecontents of the tables referenced in thisfinal rule, we refer readers to section VI.of the Addendum to this final rule.Readers who experience any problemsaccessing any of the tables that areposted on the CMS Web sites identifiedabove should contact Michael Treitel at(410) 786–4552.sradovich on DSK3GMQ082PROD with RULES2Acronyms3M 3M Health Information SystemAAMC Association of American MedicalCollegesACGME Accreditation Council for GraduateMedical EducationACoS American College of SurgeonsAHA American Hospital AssociationAHIC American Health InformationCommunityAHIMA American Health InformationManagement AssociationAHRQ Agency for Healthcare Research andQualityAJCC American Joint Committee on CancerALOS Average length of stayALTHA Acute Long-Term HospitalAssociationAMA American Medical AssociationAMGA American Medical GroupAssociationAMI Acute myocardial infarctionAO Accrediting OrganizationsAOA American Osteopathic AssociationAPR DRG All Patient Refined DiagnosisRelated Group SystemAPRN Advanced practice registered nurseARRA American Recovery andReinvestment Act of 2009, Public Law111–5ASCA Administrative SimplificationCompliance Act of 2002, Public Law 107–105VerDate Sep 11 201423:27 Aug 11, 2017Jkt 241001ASITN American Society of Interventionaland Therapeutic NeuroradiologyASPE Assistant Secretary for Planning andEvaluation (DHHS)ATRA American Taxpayer Relief Act of2012, Public Law 112–240BBA Balanced Budget Act of 1997, PublicLaw 105–33BBRA Medicare, Medicaid, and SCHIP[State Children’s Health InsuranceProgram] Balanced Budget Refinement Actof 1999, Public Law 106–113BIPA Medicare, Medicaid, and SCHIP [StateChildren’s Health Insurance Program]Benefits Improvement and Protection Actof 2000, Public Law 106–554BLS Bureau of Labor StatisticsCABG Coronary artery bypass graft[surgery]CAH Critical access hospitalCARE [Medicare] Continuity AssessmentRecord & Evaluation [Instrument]CART CMS Abstraction & Reporting ToolCAUTI Catheter-associated urinary tractinfectionCBSAs Core-based statistical areasCC Complication or comorbidityCCN CMS Certification NumberCCR Cost-to-charge ratioCDAC [Medicare] Clinical Data AbstractionCenterCDAD Clostridium difficile-associateddiseaseCDC Centers for Disease Control andPreventionCEHRT Certified electronic health recordtechnologyCERT Comprehensive error rate testingCDI Clostridium difficile [C. difficile]infectionCFR Code of Federal RegulationsCLABSI Central line-associatedbloodstream infectionCIPI Capital input price indexCMI Case-mix indexCMS Centers for Medicare & MedicaidServicesCMSA Consolidated MetropolitanStatistical AreaCOBRA Consolidated OmnibusReconciliation Act of 1985, Public Law 99–272COLA Cost-of-living adjustmentCoP [Hospital] condition of participationCOPD Chronic obstructive pulmonarydiseaseCPI Consumer price indexCQL Clinical quality languageCQM Clinical quality measureCY Calendar yearDACA Data Accuracy and CompletenessAcknowledgementDPP Disproportionate patient percentageDRA Deficit Reduction Act of 2005, PublicLaw 109–171DRG Diagnosis-related groupDSH Disproportionate share hospitalEBRT External beam radiotherapyECE Extraordinary circumstancesexemptionECI Employment cost indexeCQM Electronic clinical quality measureEDB [Medicare] Enrollment DatabaseEHR Electronic health recordEMR Electronic medical recordEMTALA Emergency Medical Treatmentand Labor Act of 1986, Public Law 99–272PO 00000Frm 00003Fmt 4701Sfmt 470037991EP Eligible professionalFAH Federation of American HospitalsFDA Food and Drug AdministrationFFY Federal fiscal yearFPL Federal poverty lineFQHC Federally qualified health centerFR Federal RegisterFTE Full-time equivalentFY Fiscal yearGAF Geographic Adjustment FactorGME Graduate medical educationHAC Hospital-acquired conditionHAI Healthcare-associated infectionHCAHPS Hospital Consumer Assessment ofHealthcare Providers and SystemsHCFA Health Care FinancingAdministrationHCO High-cost outlierHCP Healthcare personnelHCRIS Hospital Cost Report InformationSystemHF Heart failureHHA Home health agencyHHS Department of Health and HumanServicesHICAN Health Insurance Claims AccountNumberHIPAA Health Insurance Portability andAccountability Act of 1996, Public Law104–191HIPC Health Information Policy CouncilHIS Health information systemHIT Health information technologyHMO Health maintenance organizationHPMP Hospital Payment MonitoringProgramHSA Health savings accountHSCRC [Maryland] Health Services CostReview CommissionHSRV Hospital-specific relative valueHSRVcc Hospital-specific relative valuecost centerHQA Hospital Quality AllianceHQI Hospital Quality InitiativeHwH Hospital-within-hospitalHWR Hospital-wide readmissionICD–9–CM International Classification ofDiseases, Ninth Revision, ClinicalModificationICD–10–CM International Classification ofDiseases, Tenth Revision, ClinicalModificationICD–10–PCS International Classification ofDiseases, Tenth Revision, ProcedureCoding SystemICR Information collection requirementICU Intensive care unitIGI IHS Global, Inc.IHS Indian Health ServiceIME Indirect medical educationIMPACT Act Improving Medicare PostAcute Care Transformation Act of 2014,Public Law 113–185I–O Input-OutputIOM Institute of MedicineIPF Inpatient psychiatric facilityIPFQR Inpatient Psychiatric FacilityQuality Reporting [Program]IPPS [Acute care hospital] inpatientprospective payment systemIRF Inpatient rehabilitation facilityIQR [Hospital] Inpatient Quality ReportingLAMCs Large area metropolitan countiesLDS Limited Data SetLOS Length of stayLTC–DRG Long-term care diagnosis-relatedgroupE:\FR\FM\14AUR2.SGM14AUR2
sradovich on DSK3GMQ082PROD with RULES237992Federal Register / Vol. 82, No. 155 / Monday, August 14, 2017 / Rules and RegulationsLTCH Long-term care hospitalLTCH QRP Long-Term Care HospitalQuality Reporting ProgramMA Medicare AdvantageMAC Medicare Administrative ContractorMACRA Medicare Access and CHIPReauthorization Act of 2015, Public Law114–10MAP Measure Application PartnershipMCC Major complication or comorbidityMCE Medicare Code EditorMCO Managed care organizationMDC Major diagnostic categoryMDH Medicare-dependent, small ruralhospitalMedPAC Medicare Payment AdvisoryCommissionMedPAR Medicare Provider Analysis andReview FileMEI Medicare Economic IndexMGCRB Medicare Geographic ClassificationReview BoardMIEA–TRHCA Medicare Improvements andExtension Act, Division B of the Tax Reliefand Health Care Act of 2006, Public Law109–432MIPPA Medicare Improvements for Patientsand Providers Act of 2008, Public Law110–275MMA Medicare Prescription Drug,Improvement, and Modernization Act of2003, Public Law 108–173MMEA Medicare and Medicaid ExtendersAct of 2010, Public Law 111–309MMSEA Medicare, Medicaid, and SCHIPExtension Act of 2007, Public Law 110–173MOON Medicare Outpatient ObservationNoticeMRHFP Medicare Rural Hospital FlexibilityProgramMRSA Methicillin-resistant StaphylococcusaureusMSA Metropolitan Statistical AreaMS–DRG Medicare severity diagnosisrelated groupMS–LTC–DRG Medicare severity long-termcare diagnosis-related groupMU Meaningful Use [EHR IncentiveProgram]MUC Measure under considerationNAICS North American IndustrialClassification SystemNALTH National Association of Long TermHospitalsNCD National coverage determinationNCHS National Center for Health StatisticsNCQA National Committee for QualityAssuranceNCVHS National Committee on Vital andHealth StatisticsNECMA New England County MetropolitanAreasNHSN National Healthcare Safety NetworkNOP Notice of ParticipationNOTICE Act Notice of ObservationTreatment and Implication for CareEligibility Act, Public Law 114–42NQF National Quality ForumNQS National Quality StrategyNTIS National Technical InformationServiceNTTAA National Technology Transfer andAdvancement Act of 1991, Public Law104–113NUBC National Uniform Billing CodeNVHRI National Voluntary HospitalReporting InitiativeVerDate Sep 11 201423:27 Aug 11, 2017Jkt 241001OACT [CMS’] Office of the ActuaryOBRA 86 Omnibus Budget ReconciliationAct of 1986, Public Law 99–509OES Occupational employment statisticsOIG Office of the Inspector GeneralOMB [Executive] Office of Management andBudgetONC Office of the National Coordinator forHealth Information TechnologyOPM [U.S.] Office of PersonnelManagementOQR [Hospital] Outpatient QualityReportingO.R. Operating roomOSCAR Online Survey Certification andReporting [System]PAC Post-acute carePAMA Protecting Access to Medicare Act of2014, Public Law 113–93PCH PPS-exempt cancer hospitalPCHQR PPS-exempt cancer hospital qualityreportingPMSAs Primary metropolitan statisticalareasPOA Present on admissionPPI Producer price indexPPR Potentially Preventable ReadmissionsPPS Prospective payment systemPRA Paperwork Reduction ActPRM Provider Reimbursement ManualProPAC Prospective Payment AssessmentCommissionPRRB Provider Reimbursement ReviewBoardPRTFs Psychiatric residential treatmentfacilitiesPSF Provider-Specific FilePSI Patient safety indicatorPS&R Provider Statistical andReimbursement [System]PQRS Physician Quality Reporting SystemPUF Public use fileQDM Quality data modelQIES ASAP Quality ImprovementEvaluation System Assessment Submissionand ProcessingQIG Quality Improvement Group [CMS]QIO Quality Improvement OrganizationQM Quality measureQPP Quality Payment ProgramQRDA Quality Reporting DocumentArchitectureRFA Regulatory Flexibility Act, Public Law96–354RHC Rural health clinicRHQDAPU Reporting hospital quality datafor annual payment updateRIM Reference information modelRNHCI Religious nonmedical health careinstitutionRPL Rehabilitation psychiatric long-termcare (hospital)RRC Rural referral centerRSMR Risk-standard mortality rateRSP Risk-standardized paymentRSSR Risk-standard readmission rateRTI Research Triangle Institute,InternationalRUCAs Rural-urban commuting area codesRY Rate yearSAF Standard Analytic FileSCH Sole community hospitalSCHIP State Child Health InsuranceProgramSCIP Surgical Care Improvement ProjectSFY State fiscal yearPO 00000Frm 00004Fmt 4701Sfmt 4700SGR Sustainable Growth RateSIC Standard Industrial ClassificationSIR Standardized infection ratioSNF Skilled nursing facilitySNF QRP Skilled Nursing Facility QualityReporting ProgramSNF VBP Skilled Nursing Facility ValueBased PurchasingSOCs Standard occupational classificationsSOM State Operations ManualSRR Standardized risk ratioSSI Surgical site infectionSSI Supplemental Security IncomeSSO Short-stay outlierSUD Substance use disorderTEFRA Tax Equity and FiscalResponsibility Act of 1982, Public Law 97–248TEP Technical expert panelTHA/TKA Total hip arthroplasty/total kneearthroplastyTMA TMA [Transitional MedicalAssistance], Abstinence Education, and QI[Qualifying Individuals] ProgramsExtension Act of 2007, Public Law 110–90TPS Total Performance ScoreUHDDS Uniform hospital discharge data setUR Utilization reviewVBP [Hospital] Value Based Purchasing[Program]VTE Venous thromboembolismTable of ContentsI. Executive Summary and BackgroundA. Executive Summary1. Purpose and Legal Authority2. Summary of the Major Provisions3. Summary of Costs and BenefitsB. Summary1. Acute Care Hospital InpatientProspective Payment System (IPPS)2. Hospitals and Hospital Units Excludedfrom the IPPS3. Long-Term Care Hospital ProspectivePayment System (LTCH PPS)4. Critical Access Hospitals (CAHs)5. Payments for Graduate MedicalEducation (GME)C. Summary of Provisions of RecentLegislation Implemented in This FinalRule1. The American Taxpayer Relief Act of2012 (ATRA) (Pub. L. 112–240), theMedicare Access and CHIPReauthorization Act of 2015 (MACRA)(Pub. L. 114–10), and the 21st CenturyCures Act (Pub. L. 114–255)2. Pathway for SGR Reform Act of 2013(Pub. L. 113–67)3. Improving Medicare Post-Acute CareTransformation Act of 2014 (IMPACTAct) (Pub. L. 113–185)4. The Medicare Access and CHIPReauthorization Act of 2015 (MACRA)(Pub. L. 114–10)5. The 21st Century Cures Act (Pub. L.114–255)D. Issuance of Notice of ProposedRulemakingII. Changes to Medicare Severity DiagnosisRelated Group (MS–DRG) Classificationsand Relative WeightsA. BackgroundB. MS–DRG ReclassificationsC. Adoption of the MS–DRGs in FY 2008D. FY 2018 MS–DRG Documentation andCoding AdjustmentE:\FR\FM\14AUR2.SGM14AUR2
sradovich on DSK3GMQ082PROD with RULES2Federal Register / Vol. 82, No. 155 / Monday, August 14, 2017 / Rules and Regulations1. Background on the Prospective MS–DRGDocumentation and Coding Adjustmentsfor FY 2008 and FY 2009 Authorized byPublic Law 110–902. Recoupment or Repayment AdjustmentAuthorized by Section 631 of theAmerican Taxpayer Relief Act of 2012(ATRA)3. Adjustment for FY 2018 Required UnderSection 414 of Public Law 114–10(MACRA) and Section 15005 of PublicLaw 114–255E. Refinement of the MS–DRG RelativeWeight Calculation1. Background2. Discussion of Policy for FY 2018F. Changes to Specific MS–DRGClassifications1. Discussion of Changes to Coding Systemand Basis for FY 2018 MS–DRG Updatesa. Conversion of MS–DRGs to theInternational Classification of Diseases,10th Revision (ICD–10)b. Basis for FY 2018 MS–DRG Updates2. MDC 1 (Diseases and Disorders of theNervous System)a. Functional Quadriplegiab. Responsive Neurostimulator (RNS )Systemc. Precerebral Occlusion or TransientIschemic Attack With Thrombolytic3. MDC 2 (Diseases and Disorders of theEye: Swallowing Eye Drops(Tetrahydrozoline))4. MDC 5 (Diseases and Disorders of theCirculatory System)a. Percutaneous Cardiovascular Proceduresand Insertion of a Radioactive Elementb. Modification of the Titles for MS–DRG246 (Percutaneous CardiovascularProcedures With Drug-Eluting StentWith MCC or 4 Vessels or Stents) andMS–DRG 248 (PercutaneousCardiovascular Procedures With NonDrug-Eluting Stent With MCC or 4 Vessels or Stents)c. Transcatheter Aortic Valve Replacement(TAVR) and Left Atrial AppendageClosure (LAAC)d. Percutaneous Mitral Valve ReplacementProcedurese. Percutaneous Tricuspid Valve Repair5. MDC 8 (Diseases and Disorders of theMusculoskeletal System and ConnectiveTissue)a. Total Ankle Replacement (TAR)Proceduresb. Revision of Total Ankle Replacement(TAR) Proceduresc. Magnetic Controlled Growth Rods(MAGEC System)d. Combined Anterior/Posterior SpinalFusion6. MDC 14 (Pregnancy, Childbirth and thePuerperium)a. Vaginal Delivery and ComplicatingDiagnosesb. MS–DRG 998 (Principal DiagnosisInvalid as Discharge Diagnosis)c. MS–DRG 782 (Other AntepartumDiagnoses Without MedicalComplications)d. Shock During or Following Labor andDelivery7. MDC 15 (Newborns and Other Neonateswith Conditions Originating in PerinatalVerDate Sep 11 201423:27 Aug 11, 2017Jkt 241001Period): Observation and Evaluation ofNewborn8. MDC 21 (Injuries, Poisonings and ToxicEffects of Drugs): Complication Codes9. MDC 23 (Factors Influencing HealthStatus and Other Contacts With HealthServices): Updates to MS–DRGs 945 and946 (Rehabilitation With CC/MCC andWithout CC/MCC, Respectively)10. Changes to the Medicare Code Editor(MCE)a. Age Conflict Editb. Sex Conflict Editc. Non-Covered Procedure Editd. Unacceptable Principal Diagnosis Edite. Future Enhancement11. Changes to Surgical Hierarchies12. Changes to the MS–DRG DiagnosisCodes for FY 2018a. Background of the CC List and the CCExclusions Listb. Additions and Deletions to the DiagnosisCode Severity Levels for FY 2018c. Principal Diagnosis Is Its Own CC orMCCd. CC Exclusions List for FY 201813. Comprehensive Review of CC List forFY 201914. Review of Procedure Codes in MSDRGs 981 Through 983; 984 Through986; and 987 Through 989a. Moving Procedure Codes From MS–DRGs 981 Through 983 or MS–DRGs 987Through 989 Into MDCsb. Reassignment of Procedures Among MS–DRGs 981 Through 983, 984 Through986, and 987 Through 98915. Changes to the ICD–10–CM and ICD–10–PCS Coding Systems16. Replaced Devices Offered Without Costor With a Credita. Backgroundb. Changes for FY 201817. Other Policy Changes: Other OperatingRoom (O.R.) and Non-O.R. Issuesa. O.R. Procedures to Non-O.R. Proceduresb. Revision of Neurostimulator Generatorc. External Repair of Hymend. Non-O.R. Procedures in MDC 17(Myeloproliferative Diseases andDisorders Poorly DifferentiatedNeoplasms)G. Recalibration of the FY 2018 MS–DRGRelative Weights1. Data Sources for Developing the RelativeWeights2. Methodology for Calculation of theRelative Weights3. Development of National Average CCRsH. Add-On Payments for New Services andTechnologies for FY 20181. Background2. Public Input Before Publication of aNotice of Proposed Rulemaking on AddOn Payments3. ICD–10–PCS Section ‘‘X’’ Codes forCertain New Medical Services andTechnologies4. Revision of Reference to an ICD–9–CMCode in § 412.87(b)(2) of the Regulations5. FY 2018 Status of TechnologiesApproved for FY 2017 Add-On Paymentsa. CardioMEMSTM HF (Heart Failure)Monitoring Systemb. Defitelio (Defibrotide)c. GORE EXCLUDER Iliac BranchEndoprosthesis (IBE)PO 00000Frm 00005Fmt 4701Sfmt 470037993d. Idarucizumabe. Lutonix Drug Coated Balloon PTACatheter and In.PACTTM AdmiralTMPaclitaxel Coated PercutaneousTransluminal Angioplasty (PTA) BalloonCatheterf. MAGEC Spinal Bracing and DistractionSystem (MAGEC Spine)g. VistogardTM (Uridine Triacetate)h. Blinatumomab (BLINCYTOTM TradeBrand)6. FY 2018 Applications for NewTechnology Add-On Paymentsa. Bezlotoxumab (ZINPLAVATM)b. EDWARDS INTUITY EliteTM ValveSystem (INTUITY) and Liva NovaPerceval Valve (Perceval)c. Ustekinumab (Stelara )III. Changes to the Hospital Wage Index forAcute Care HospitalsA. Background1. Legislative Authority2. Core-Based Statistical Areas (CBSAs) forthe FY 2018 Hospital Wage Index3. Codes for Constituent Counties inCBSAsB. Worksheet S–3 Wage Data for the FY2018 Wage Index1. Included Categories of Costs2. Excluded Categories of Costs3. Use of Wage Index Data by Suppliersand Providers Other Than Acute CareHospitals Under the IPPSC. Verification of Worksheet S–3 WageDataD. Method for Computing the FY 2018Unadjusted Wage Index1. Methodology for FY 20182. Clarification of Other Wage RelatedCosts in the Wage IndexE. Occupational Mix Adjustment to the FY2018 Wage Index1. Use of 2013 Occupational Mix Surveyfor the FY 2018 Wage Index2. Use of the 2016 Medicare Wage IndexOccupational Mix Survey for the FY2019 Wage Index3. Calculation of the Occupational MixAdjustment for FY 2018F. Analysis and Implementation of theOccupational Mix Adjustment and theFY 2018 Occupational Mix AdjustedWage IndexG. Application of the Rural, Imputed, andFrontier Floors1. Rural Floor2. Expiration of the Imputed Floor Policy3. State Frontier Floor for FY 2018H. FY 2018 Wage Index TablesI. Revisions to the Wage Index Based onHospital Redesignations andReclassifications1. General Policies and Effects ofReclassification and Redesignation2. MGCRB Reclassification andRedesignation Issues for FY 2018a. FY 2018 Reclassification Requirementsand Approvalsb. Extension of PRA Information CollectionRequirement Approval for MGCRBApplicationsc. Deadline for Submittal of Documentationof Sole Community Hospital (SCH) andRural Referral Center (RRC)Classification Status to the MGCRBE:\FR\FM\14AUR2.SGM14AUR2
sradovich on DSK3GMQ082PROD with RULES237994Federal Register / Vol. 82, No. 155 / Monday, August 14, 2017 / Rules and Regulationsd. Clarification of Special Rules for SCHsand RRCs Reclassifying to GeographicHome Area3. Redesignations Under Section1886(d)(8)(B) of the Act4. Changes to the 45-Day Notification RulesJ. Out-Migration Adjustment Based onCommuting Patterns of HospitalEmployeesK. Reclassification From Urban to RuralUnder Section 1886(d)(8)(E) of the ActImplemented at 42 CFR 412.103L. Clarification of Application Deadline forRural Referral Center (RRC)ClassificationM. Process for Requests for Wage IndexData Corrections1. Process for Hospitals to Accept WageIndex Data Corrections2. Process for Wage Index Data Correctionsby CMS After the January Public Use File(PUF)N. Labor Market Share for the FY 2018Wage IndexIV. Rebasing and Revising of the HospitalMarket Baskets for Acute Care HospitalsA. BackgroundB. Rebasing and Revising the IPPS MarketBasket1. Development of Cost Categories andWeightsa. Use of Medicare Cost Report Datab. Final Major Cost Category Computationc. Derivation of the Detailed Cost Weights2. Selection of Price Proxies3. Labor-Related ShareC. Market Basket for Certain HospitalsPresently Excluded From the IPPSD. Rebasing and Revising the Capital InputPrice Index (CIPI)V. Other Decisions and Changes to the IPPSfor Operating CostsA. Changes to MS–DRGs Subject toPostacute Care Transfer and MS–DRGSpecial Payment PoliciesB. Changes in the Inpatient HospitalUpdates for FY 2018 (§ 412.64(d))1. FY 2018 Inpatient Hospital Update2. FY 2018 Puerto Rico Hospital UpdateC. Change to Volume Decrease Adjustmentfor Sole Community Hospitals (SCHs)and Medicare-Dependent, Small RuralHospitals (MDHs) (§ 412.92)1. Background2. Changes to the Volume DecreaseAdjustment Calculation Methodology forSCHsD. Rural Referral Centers (RRCs): AnnualUpdates to Case-Mix Index (CMI) andDischarge Criteria (§ 412.96)1. Case-Mix Index (CMI)2. DischargesE. Payment Adjustment for Low-VolumeHospitals (§ 412.101)1. Expiration of Temporary Changes toLow-Volume Hospital Payment Policy2. Background3. Payment Adjustment for FY 2018 andSubsequent Fiscal Years4. Parallel Low-Volume Hospital PaymentAdjustment Regarding HospitalsOperated by the Indian Health Service(IHS) or a TribeF. Indirect Medical Education (IME)Payment Adjustment (§ 412.105)VerDate Sep 11 201423:27 Aug 11, 2017Jkt 241001G. Payment Adjustment for MedicareDisproportionate Share Hospitals (DSHs)for FY 2018 (§ 412.106)1. General Discussion2. Eligibility for Empirically JustifiedMedicare DSH Payments andUncompensated Care Payments3. Empirically Justified Medicare DSHPayments4. Uncompensated Care Paymentsa. Calculation of Factor 1 for FY 2018b. Calculation of Factor 2 for FY 2018(1) Background(2) Methodology for Calculation of Factor2 for FY 2018c. Calculation of Factor 3 for FY 2018(1) Background(2) Data Source for FY 2018(3) Time Period for Calculating Factor 3 forFY 2018, Including Methodology forIncorporating Worksheet S–10 Data(4) Methodological Considerations forCalculating Factor 3(5) Methodological Considerations forIncorporating Worksheet S–10 DataH. Medicare-Dependent, Small RuralHospital (MDH) Program (§ 412.108)1. Background for the MDH Programa. Expiration of the MDH ProgramI. Hospital Readmissions ReductionProgram: Updates and Changes(§§ 412.150 Through 412.154)1. Statutory Basis for the HospitalReadmissions Reduction Program2. Regulat
Lisa Marie Gomez, (410) 786-1175, EHR Incentive Program Clinical Quality Measure Related Issues. Kathleen Johnson, (410) 786-3295, and Steven Johnson (410) 786-3332, EHR Incentive Program Nonclinical Quality Measure Related Issues. Caecilia Blondiaux, (410), 786-2190, and Ariadne Saklas, (410) 786-3322, Changes in Notice of Termination of
